Which drug interaction can lead to digoxin toxicity?

Digoxin is a medication commonly used to treat heart failure and certain arrhythmias. The interaction between digoxin and verapamil that can lead to digoxin toxicity is particularly significant. Verapamil is a calcium channel blocker that can increase the plasma concentration of digoxin by inhibiting its metabolism and renal clearance.

When digoxin levels rise, they can exceed the therapeutic range, potentially leading to toxicity. Symptoms of digoxin toxicity include nausea, vomiting, confusion, visual disturbances (such as the appearance of yellow or green halos), and arrhythmias. This risk of toxicity makes it crucial for healthcare providers to monitor digoxin levels and the patient's clinical status when starting or adjusting doses of verapamil in patients taking digoxin.

In contrast, while amiodarone can also interact with digoxin and contribute to toxicity, it primarily affects digoxin levels through different mechanisms, and the degree of risk may be less pronounced compared to verapamil. Metoprolol, a beta-blocker, does not have the same direct interactions with digoxin. Aspirin does not have a relevant interaction with digoxin that would lead to toxicity. Understanding these interactions is vital for providing safe and effective care for patients on digoxin therapy.